Arrhythmias, also known as cardiac arrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow.[2] Essentially, this is anything but normal sinus rhythm. A resting heart rate that is too fast – above 100 beats per minute in adults – is called tachycardia, and a resting heart rate that is too slow – below 60 beats per minute – is called bradycardia.[2] Some types of arrhythmias have no symptoms.[1] Symptoms, when present, may include palpitations or feeling a pause between heartbeats.[1] In more serious cases, there may be lightheadedness, passing out, shortness of breath, chest pain, or decreased level of consciousness.[1] While most cases of arrhythmia are not serious, some predispose a person to complications such as stroke or heart failure.[2][3] Others may result in sudden death.[3]

1. CARDIAC
ARRHYTHMIA
From: Aishwarya L D
3rd
year CCT.

2. DEFINITION :-
Arrhythmias are deviations from Normal heart beat
pattern. They include abnormalities of impulse formation,
such as heart rate, rhythm or site of impulse origin and
conduction disturbances, which disrupt the normal
sequence of atrial and ventricular activation.

4. CLASSIFICATION :-
1. TACHYARRHYTHMIA
a) Atrial :
- Atrial fibrillation
- Atrial flutter
- PSVT(Paroxysmal Supraventricular Tachycardia)
- Automatic atrial tachycardia atrial extrasystol

5. b) Ventricle :
- VPC ( Ventricular premature complexes)
- Ventricular flutter
- Ventricular fibrillation
- Ventricular tachycardia (VT)
• Sustained VT
• Non-sustained VT

6. VPC :
• Due to the premature discharge of an ectopic ventricular focus.
• CAUSES – Hypokalemia, Hypomagnesemia, Digoxin
toxicity and Excess caffeine.
• ECG : HR - variable
Rhythm – irregular
P wave - no P waves associated
with premature beats.
PRi – Not accurate
QRS – wide > 0.12sec , bizarre

7. VENTRICULAR FLUTTER :
• It occurs due to rapid and regular discharge from an ectopic focus within the
ventricles.
• HR – 150 to 300 bpm
• Rhythm – regular
• P wave – no
• PRi – not accurate
• QRS – wide, > 0.12sec,
bizarre, sine wave form.

8. VENTRICULAR FIBRILLATION :
• It is chaotic (undefined) depolarization of ventricles.
• CAUSES – MI, sever CM, Drug intoxication ( digitalis, quinidine)
Accidental event ( electrical shock, hypothermia)
• ECG : HR – Very rapid ( 350 to 500 bpm)
Rhythm – chaotic
P wave – none
PRi - not accurate
QRS – none, (absent ST – segment,
P wave, T wave )

9. VENTRICULAR TACHYCARDIA :
• Deadly rhythm, rapid discharge of an ectopic ventricular pacemaking focus.
• CAUSES – Acute MI , myocarditis, chronic IHD with poor LVF, ventricular
Aneurysm, Electrolyte imbalance.
• ECG : HR – 100 to 200 bpm
Rhythm – regular
P wave – no p wave corresponding
to QRS ( few may seen)
PRi. - not accurate
QRS - > 0.12 sec.

10. Sustained VT & Non- sustained VT :

11. 2. BRADYARRHYTHMIA :-
a) Sino-atrial block (SA block) b) Atrio-ventricular block ( AV block )
• 1° SA block • 1° AV block
• 2° SA block • 2° AV block
- Type - 1 - Mobitz type – 1
- Type - 2 - Mobitz type – 2
• 3° SA block • 3° AV block
1. Cardiac asystole ( Complete heart block)
2. Sinus arrest / pause
3. Sinus bradycardia
4. Sick Sinus Syndrome ( SSS)

12. 1. SINO-ATRIAL BLOCK
• Sinus node impulses is blocked within SA- junction.
• As a result, neither atrial / ventricular activation takes place , so
drop-out seen

13. 1° SAB -
• Firing of SA node not seen in ECG.
• EP studies shows SA conduction Time.
2° SAB –
1. Type 1:
• Progressive prolongation of SA conduction Time till SN
impulse is not conducted to atria.
• Dropped “P” wave.
• PP progressively shortens.

14. 2. Type -2 :-
• Dropped P wave without progressive prolongation of
SA conduction Time.
• No changes in PRi.

15. 3° SAB -
• Complete cessation of SA conduction and manifests
as - absence of P waves.
- junctional escape rhythm.
• Occurs in – Sinus bradycardia, Digitalis
administration, athletes.

16. 2. CARDIAC ASYSTOLE :
• It is a cardiac arrest rhythm with no electrical activity on the ECG monitor.
• Heart is not functioning, life-threatening.
• ECG - Flat line ECG
- HR
- Rhythm
- P waves
- PRc
- QRS
• Rx - Epinephrine: 1mg/IV/ID with CPR.
- Defibrillation, ICD.

17. 3. SINUS ARREST :
• Rate – non accurate
• Rhythm – irregular
• P wave – normal
• QRS - <0.12
• PRc - 0.12 – 0.2 sec

18. 4. SINUS PAUSE :
• One dropped beat is a sinus pause.
5. SINUS BRADYCARDIA :
• HR - <60 bpm
• Rhythm - regular
• P wave - normal
• PRc - prolonged
• QRS - normal

19. 6. SICK – SINUS SYNDROME (SSS) :
• SSS describes dysfunction of the intrinsic Pacemaker of the
heart, the SA node.
• It is also called as Tachy-Brady syndrome.
• CAUSES – Idiopathic degeneration ischemia, CM,
ectrolyte disturbance, Tachy-Brady syndrome
Arystole.
• SYMPTOMS - Dizziness and syncope.
- Dyspnea and fatigue.
- Palpitation and angina.
- Confusion and Dementia

20. • ECG – Sinus bradycardia
- Sinoatrial exit block
- Slow AF
- Junctional escape rhythm
- Tachy-Brady syndrome
- Sinus arrhythmia.

21. b) AV BLOCKS :-
1. 1° AV block :
• HR - Normal
• Rhythm - Regular
• P wave - before QRS ( identical)
• PRi - >0.20sec
• QRS - <0.12sec

22. 2. 2° AV block :
• Mobitz type – 1 :
• HR – N / slow
• Rhythm – irregular
• P wave – Not followed by QRS
• PRi - progressively longer until dropped beat and cycle is
repeated again.
• QRS - < 0.12 sec

23. • Mobitz type -2 :
• HR – usually slow
• Rhythm – regular or irregular
• P wave - No progressive increase in Pri,some P waves have QRS
Complexes following them while others do not,for no
apparent reason.
• PRi - 0.12 to 0.2 sec
• QRS - < 0.12 sec ( depends)

24. 3. 3° AV block ( CHB ) :
• HR – 30 to 60 bpm
• Rhythm – regular
• P wave – present, but not relation between P & QRS
• PRi – varies
• QRS - <0.12sec (depends)

25. THANK YOU..